MEDICARE: EAR NOSE AND THROAT ASSOCIATES OF JOHNSTOWN, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207YX0602X	Otolaryngic Allergy Physician
2	207Y00000X	Otolaryngology Physician

General Provider Information

NPI Number	:	1164534319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAR NOSE AND THROAT ASSOCIATES OF JOHNSTOWN, INC.

Provider Business Mailing Address
First Line	:	348 BUDFIELD STREET
Second Line	:
City	:	JOHNSTOWN
State	:	PA
Zip	:	15904-3214
Country	:	US
Telephone Number	:	814-262-3950
Fax Number	:	814-262-3990

Provider Business Practice Location Address
First Line	:	348 BUDFIELD STREET
Second Line	:
City	:	JOHNSTOWN
State	:	PA
Zip	:	15904-3214
Country	:	US
Telephone Number	:	814-262-3950
Fax Number	:	814-262-3990

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DAVID R ROGERSON
Credential	:	MD
Telephone Number	:	814-262-3953

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	06/26/2009

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